Dimensions, application, and outcomes of person-centered self-management interventions for those living with type 2 diabetes: A scoping review.

OBJECTIVES: To explore which dimensions of the person-centered approach (PCA) are adopted in self-management interventions, how they are applied, and its outcomes. METHODS: A review team carried out a scoping review using the methodology of Arksey and O'Malley on diabetes mellitus type 2, person-centered care, and self-management. RESULTS: Of the 364 titles identified, 22 articles were included in this review. No study contained all five dimensions described by the person-centered framework. Some dimensions seemed difficult to assess, mainly having a sympathetic presence and engagement. The application of the five PCA dimensions are presented. Although the authors claimed their intervention to be person-centered, none used a specific tool to measure person-centered care in a holistic way. CONCLUSION: Although the guidelines recommend a PCA to professionals, there is a gap with practice, professionals having difficulty adopting and measuring this approach. PRACTICE IMPLICATIONS: Some strategies to facilitate the adoption of a PCA with people living with type 2 diabetes are proposed. These can help researchers and clinicians develop a PCA, by identifying the care delivery processes necessary to provide it. It seems important for researchers to measure whether their intervention is truly person-centered, using holistic tools and combining different methods (observation, questionnaire, interview).

Lateral septum-medial hypothalamic connections: an electrophysiological study in the rat.

Participation of both the lateral septum and the medial hypothalamus in similar behavioral and homeostatic functions, combined with anatomical data indicating a modest descending lateral septum projection to medial hypothalamic areas, prompted an investigation of the electrophysiology of lateral septum--medial hypothalamic connections in pentobarbital-anesthetized male Sprague-Dawley rats. Field potentials evoked by lateral septum stimulation were prominent within the hypothalamic ventromedial nucleus: their distribution closely overlapped with amygdala-evoked field potentials. Lateral septum stimulation evoked orthodromic responses from 67% of 800 medial hypothalamic and preoptic neurons (55.5% excitatory, latency 17.5 +/- 0.5 ms; 11.5% inhibitory, latency 19.1 +/- 1.4 ms), including 15 of 31 tuberoinfundibular neurons activated antidromically from the median eminence, 37.4% of cells responded orthodromically to both lateral septum and amygdala stimulation, whereas only 5.8% of cells demonstrated orthodromic responses to both lateral septum and midbrain periaqueductal gray stimulation. These observations suggest that lateral septum neurons influence the excitability of many medial preoptic and hypothalamic neurons, and indicate a convergence of lateral septum and amygdala influences onto 37% of medial hypothalamic cells. In the rat, the lateral septum's influence on adenohypophyseal hormone secretion appears to be mediated indirectly, i.e. through monosynaptic connections with medial hypothalamic tuberoinfundibular neurons.

Ophthalmic microsurgical robot and associated virtual environment.

An ophthalmic virtual environment has been developed as part of a teleoperated microsurgical robot built to perform surgery on the eye. The virtual environment is unique in that it incorporates a detailed continuum model of the anatomical structures of the eye, its mechanics and optical properties, together with a less detailed geometric-mechanical model of the face. In addition to providing a realistic visual display of the eye being operated on, the virtual environment simulates tissue properties during manipulation and cutting and the forces involved are determined by solving a mechanical finite element model of the tissue. These forces are then fed back to the operator via a force reflecting master and so the surgeon can experience both the visual and mechanical sensations associated with performing surgery. The virtual environment can be used to enhance the images produced by the camera on the microsurgical slave robot during surgery and as a surgical simulator in which it replaces these images with computer graphics generated from the eye model.

[Pulmonary and renal involvement in a TNFα antagonist drug-induced sarcoidosis]. / Sarcoïdose pneumo-rénale apparue sous anti-TNFα.

Several cases of sarcoidosis with pulmonary, neurological or ophthalmological involvement occurring during a treatment by anti-TNFα have been reported in the literature. We report a 66-year-old man who presented with renal failure and hypercalcaemia, associated with fatigue, shortness of breath and dry cough. He was receiving infliximab since 2004 for psoriatic arthritis. The diagnosis of sarcoidosis was obtained with biopsy sampling of a mediastinal lymph node, and the lung involvement was documented with lung function tests, bronchoalveolar lavage and computed tomographic scan. Laboratory tests were suggestive of interstitial sarcoid nephritis. Disease course was favourable with corticosteroids and discontinuation of infliximab.

Viscosity discrimination: a comparison of an adaptive two-alternative forced-choice and an adjustment procedure.

Differential thresholds for viscosity were measured in ten subjects with the use of an adaptive two-alternative forced-choice procedure. An electromagnetic linear motor was connected to each wrist and the viscosity of the motors was under computer servo control. For each block of 50 trials the viscosity of one motor was fixed at a reference value which ranged from 4 to 512 N s m-1, and the viscosity of the other motor varied according to the subject's responses. On each trial subjects were required to indicate which motor had the greater viscosity and were given feedback of the correct response. By this procedure the Weber fraction for viscosity was calculated to be 19%, which is lower than the Weber fraction of 34% estimated by using the method of adjustment. The criterion used for determining the threshold differs in the two procedures (71% and 84% correct, respectively), and the results from the two studies were found to be consistent. They suggest that the Weber fraction for viscosity remains remarkably stable despite differences in the methods of measurement.

Conduction block in rat myelinated fibres following acute exposure to anti-galactocerebroside serum.

1. We have observed conduction in single rat spinal ventral root nerve fibres following acute topical application of anti-galactocerebroside serum.2. Conduction of nerve impulses was initially slowed and subsequently blocked at the site of serum exposure.3. Conduction block occurred within as little as 1 hr in more slowly conducting (20-30 m/sec) myelinated fibres but occurred later in fibres conducting more rapidly.4. Conduction block was preceded by a rise in internodal conduction time from the normal 20 musec to about 200 musec.5. At nodes exposed to serum, conduction block was invariably associated with greatly decreased depolarization; this was contrasted with nodes exposed to local anaesthetic or tetrodotoxin where conduction block occurred despite nodal depolarization well beyond threshold potential.6. Nodal capacitance and resistance were estimated from simultaneous recordings of membrane current and extracellular potential at blocked nodes exposed to local anaesthetic or tetrodotoxin (normal nodes) and at blocked nodes exposed to anti-galactocerebroside serum.7. For normal fibres of internodal length 0.8-1.1 mm, an upper limit estimate for average nodal capacitance was 2.6 +/- 0.3 pF and a lower limit estimate for average nodal resistance was 55 +/- 10 MOmega. There was an order of magnitude increase in the capacitance of nodes at which conduction block occurred following exposure to anti-galactocerebroside serum.8. We conclude that the early conduction block caused by anti-galactocerebroside serum is due to paranodal demyelination and that acute paranodal demyelination is sufficient to cause conduction block.

Connections of medial preoptic neurons with the median eminence and amygdala. An electrophysiological study in the rat.

An electrophysiological investigation was conducted on the connection of medial preoptic neurons with the median eminence and the basal and corticomedial amygdala in pentobarbital anesthesized male Sprague-Dawley rats. Of 411 medial preoptic neurons tested with median eminence stimuli, antidromic responses (mean latency 11.4 +/- SEM 0.4 ms) identified 177 cells as tuberoinfundibular neurons. Most were located in the periventricular area; 21 cells were in the area of the suprachiasmatic nucleus. Axon conduction velocities ranged between 0.01 and 0.9 m/s. 16 neurons displayed two distinct antidromic latencies when the median eminence stimulus was increased above threshold, indicating that their axons may branch in the region of the median eminence. Following suprathreshold stimulation, only 10% of spontaneously active neurons displayed features to suggest activation of a recurrent inhibitory pathway. In response to amygdala stimulation, 23% of tuberoinfundibular neurons displayed an orthodromic response; most (80%) responded with an increase in excitability after a latency of 21.6 +/- 2.4 ms; the remainder displayed a decrease in excitability at latencies of 20-28 ms lasting in excess of 100 ms. These data suggest an additional neural pathway whereby the amygdala can influence neuroendocrine regulation, i.e. through its actions on the excitability of medial preoptic tuberoinfundibular neurons.

Diagnostic considerations in evaluation of patients presenting with melena and nondiagnostic esophagogastroduodenoscopy.

Proper evaluation of patients with melena and nondiagnostic esophagogastroduodenoscopy is comparatively undefined. We sought to determine the percentage of patients with melena and nondiagnostic upper endoscopy and assess the yield of further evaluation. Of 209 patients presenting with melena, 180 underwent esophagogastroduodenoscopy as the initial study, which was nondiagnostic in 43 cases (24%). Further evaluation was pursued in 30. A presumed source of melena was found in 11 patients (37%), identified by colonoscopy in seven, bleeding scan in three, and barium enema plus flexible sigmoidoscopy in one. Nearly all such defined cases originated from the right colon. Small bowel contrast studies, flexible sigmoidoscopy of barium enema alone, and angiography failed to reveal a source. Our findings suggest that many (24%) patients presenting with melena will have nondiagnostic upper endoscopy; further evaluation reveals a potential source in 37% of this group, with the right colon being the most likely location of pathology; and colonoscopy is the test of choice in this cohort.

Analysis of short-latency reflexes in human elbow flexor muscles.

1. A motor and digital controller have been developed to apply rapid stretches to the human elbow joint. The digital controller returns the forearm to the initial position before the reflex contraction. Thus short-latency reflex responses can be cleanly separated in time from the mechanical effects of the stretch under a wide variety of loading conditions. 2. The reflex force varies linearly with the velocity of stretch over nearly 2 orders of magnitude. The reflex force also varies linearly with the tonic level of force over the entire range of forces studied (0-100 N). This contrasts sharply with, for example, the human ankle joint, which shows a very limited linear range. 3. As the digital controller is made more compliant (less stiff), reflex shortening increases dramatically and becomes more prolonged, whereas the reflex force becomes somewhat smaller and shorter. With compliant loads and the brief stretches we applied, the reflex shortening is approximately equal to the stretch that generated it. 4. Simulations of the results confirm that the dependence of reflex shortening and force on the stiffness of the load is mainly determined by the mechanics of the limb and muscles. The simulations also indicate that 1) the gain of the reflex is as high as it can be without causing instability and 2) the presence of a rectification nonlinearity (e.g., lengthening the muscle produces a reflex, but shortening the muscle does not) is mainly responsible for preserving the stability of the elbow system.

A C-terminal di-leucine is required for localization of the Menkes protein in the trans-Golgi network.

The human X-linked recessive disorder of copper metabolism, Menkes disease, is caused by a defect in the MNK ( ATP7A ) gene which encodes a transmembrane copper-transporting P-type ATPase (MNK). MNK is an important component of the mammalian copper transport pathway, and previous studies in cultured cells have localized MNK to the final compartment of the Golgi apparatus, the trans -Golgi network (TGN). At this location, MNK is predicted to supply copper to copper-dependent enzymes as they migrate through the secretory pathway. However, under conditions of elevated extracellular copper, the MNK protein undergoes a rapid relocalization to the plasma membrane where it functions in the efflux of copper from cells. In this study, three di-leucine motifs and a cluster of four acidic amino acids within the C-terminal region of MNK were investigated as candidate signals necessary for steady-state TGN localization. In vitro mutagenesis of the human MNK cDNA and immunofluorescence detection of mutant forms of MNK expressed in cultured cells demonstrated that the di-leucine, L1487L1488, was essential for localization of MNK within the TGN, but not for copper efflux. We suggest that this di-leucine motif is a putative endocytic targeting motif necessary for the retrieval of MNK from the plasma membrane to the TGN. Our data, along with the recent demonstration that the third transmembrane region of MNK functions as a TGN targeting signal, suggests that MNK localization to the TGN may be a two-step process involving TGN retention via the transmembrane region, and recycling to this compartment from the plasma membrane via the L1487L1488 motif.

Seroprevalence of human granulocytic ehrlichiosis infection in Belgium.

In order to determine the prevalence of human granulocytic ehrlichiosis (HGE) in Belgium, the sera of 216 patients previously diagnosed with Borrelia burgdorferi infection were analysed for possible coinfection with the agent of HGE. For this purpose, an indirect immunofluorescence assay was applied, and positive results were confirmed by Western blot using a 44-kilodalton recombinant protein (rP44) specific for the agent of HGE. Sixteen of the 216 (7.4%) sera tested were positive for the HGE agent using indirect immunofluorescence assay, and seven (3%) of them were confirmed positive by Western blot. These data suggest the agent for HGE is present in Belgium and may cause coinfection in patients infected with Borrelia burgdorferi, as has been reported in the USA and elsewhere in Europe. This is the first report documenting the identification of this agent in Belgium.